1
|
Nabunya P, Byansi W, Bahar OS, Namuwonge F, Atwebembere R. Emotional and Behavior Difficulties and the Mental Health of Caregivers of Adolescents Living with HIV. J Child Fam Stud 2023; 32:3766-3774. [PMID: 37362624 PMCID: PMC10256973 DOI: 10.1007/s10826-023-02609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
This study examined the relationship between child emotional and behavioral difficulties, parenting stress and the mental health of caregivers of adolescents living with HIV. Caregiver data from a two-year pilot study for adolescents and their caregivers (N = 89 dyads) in Uganda, were analyzed. Ordinary Least Square regression models were conducted to examine the association between child difficulties reported by caregivers using the Strengths and Difficulties Questionnaire on parenting stress (measured by Parenting Stress Index) and caregiver mental health (measured by the Brief Symptoms Inventory). Results indicate that 12.36% of caregivers reported child difficulty scores within the borderline range and 8.99% reported scores within the abnormal range. Child difficulties (b = 0.52, 95% CI: 0.18, 0.85) were associated with parenting stress. Similarly, the perceived impact of child difficulties was associated with both parenting stress (b = 0.89, 95% CI: 0.24, 1.54) and caregiver mental health (b = 1.73, 95% CI: 1.09, 2.37). Study findings have important implications for developing effective psychosocial interventions targeting children and adolescents living with HIV and their caregivers.
Collapse
Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, MA USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | | |
Collapse
|
2
|
Bulterys MA, Njuguna I, Mahy M, Gulaid LA, Powis KM, Wedderburn CJ, John-Stewart G. Neurodevelopment among children exposed to HIV and uninfected in sub-Saharan Africa. J Int AIDS Soc 2023; 26 Suppl 4:e26159. [PMID: 37909232 PMCID: PMC10618877 DOI: 10.1002/jia2.26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The population of 16 million children exposed to HIV and uninfected (CHEU) under 15 years of age continues to expand rapidly, and the estimated prevalence of CHEU exceeds 20% in several countries in sub-Saharan Africa with high HIV prevalence. Some evidence suggests that CHEU experience suboptimal neurodevelopmental outcomes compared to children born to women without HIV. In this commentary, we discuss the latest research on biologic and socio-behavioural factors associated with neurodevelopmental outcomes among CHEU. DISCUSSION Some but not all studies have noted that CHEU are at risk of poorer neurodevelopment across multiple cognitive domains, most notably in language and motor skills, in diverse settings, ages and using varied assessment tools. Foetal HIV exposure can adversely influence infant immune function, structural brain integrity and growth trajectories. Foetal exposure to antiretrovirals may also influence outcomes. Moreover, general, non-CHEU-specific risk factors for poor neurodevelopment, such as preterm birth, food insecurity, growth faltering and household violence, are amplified among CHEU; addressing these factors will require multi-factorial solutions. There is a need for rigorous harmonised approaches to identify children at the highest risk of delay. In high-burden HIV settings, existing maternal child health programmes serving the general population could adopt structured early child development programmes that educate healthcare workers on CHEU-specific risk factors and train them to conduct rapid neurodevelopmental screening tests. Community-based interventions targeting parent knowledge of optimal caregiving practices have shown to be successful in improving neurodevelopmental outcomes in children and should be adapted for CHEU. CONCLUSIONS CHEU in sub-Saharan Africa have biologic and socio-behavioural factors that may influence their neurodevelopment, brain maturation, immune system and overall health and wellbeing. Multidisciplinary research is needed to disentangle complex interactions between contributing factors. Common environmental and social risk factors for suboptimal neurodevelopment in the general population are disproportionately magnified within the CHEU population, and it is, therefore, important to draw on existing knowledge when considering the socio-behavioural pathways through which HIV exposure could impact CHEU neurodevelopment. Approaches to identify children at greatest risk for poor outcomes and multisectoral interventions are needed to ensure optimal outcomes for CHEU in sub-Saharan Africa.
Collapse
Affiliation(s)
- Michelle A Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Laurie A Gulaid
- UNICEF, eastern and southern Africa Regional Office, Nairobi, Kenya
| | - Katheen M Powis
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine J Wedderburn
- Department of Pediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
3
|
Odero SA, Mwangi P, Odhiambo R, Mumbua Nzioka B, Shumba C, Ndirangu-Mugo E, Abubakar A. Psychometric evaluation of PHQ-9 and GAD-7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey. Front Psychiatry 2023; 14:1123839. [PMID: 37324823 PMCID: PMC10264862 DOI: 10.3389/fpsyt.2023.1123839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya. Methods Between June and November 2021, a national survey on mental well-being and resilience among nurses/midwives and CHVs was conducted via telephone interviews. The survey had a total sample size of 1907 nurses/midwives and 2027 CHVs. Cronbach's alpha and MacDonalds' omega were used to evaluate the scale's internal consistency. Confirmatory Factor Analysis (CFA) was used to test the one-factor structure of the scales. Multi-group CFA was applied to evaluate the generalizability of the scales across the Swahili and English versions, and among male and female health workers. The Spearman correlation was used to assess the tools' divergent and convergent validity. Results The internal consistency of PHQ-9 and GAD-7 was good, with alpha and omega values above 0.7 across study samples. CFA results indicated a one-factor structure of the PHQ-9 and GAD-7 for both nurses/midwives and CHVs. Multi-group CFA showed that both scales were unidimensional across both language and sex. The PHQ-9 and GAD-7 were significantly negatively correlated with resilience and work engagement, supporting divergent validity. The PHQ-9 and GAD-7 were also significantly positively correlated with resilience and work engagement, supporting divergent validity. Conclusion The PHQ-9 and GAD-7 are unidimensional, reliable, and valid tools for screening depression and anxiety among nurses/midwives and CHVs. The tools can be administered in a similar population or study setting using either Swahili or English.
Collapse
Affiliation(s)
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
4
|
Wafula ST, Ninsiima LL, Mendoza H, Ssempebwa JC, Walter F, Musoke D. Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda. PLoS One 2023; 18:e0280338. [PMID: 37141298 PMCID: PMC10159354 DOI: 10.1371/journal.pone.0280338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda. METHODS A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. RESULTS Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31). CONCLUSION This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.
Collapse
Affiliation(s)
- Solomon T Wafula
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lesley L Ninsiima
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Hilbert Mendoza
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Florian Walter
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David Musoke
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
5
|
Angwenyi V, Kabue M, Chongwo E, Mabrouk A, Too EK, Odhiambo R, Nasambu C, Marangu J, Ssewanyana D, Njoroge E, Ombech E, Mokaya MM, Obulemire EK, Khamis A, Abubakar A. Mental Health during COVID-19 Pandemic among Caregivers of Young Children in Kenya's Urban Informal Settlements. A Cross-Sectional Telephone Survey. Int J Environ Res Public Health 2021; 18:10092. [PMID: 34639394 PMCID: PMC8508326 DOI: 10.3390/ijerph181910092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population.
Collapse
Affiliation(s)
- Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Margaret Kabue
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Adam Mabrouk
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Ezra Kipngetich Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Carophine Nasambu
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi P.O. Box 230-80108, Kenya;
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Derrick Ssewanyana
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5T 3L9, Canada
| | - Eunice Njoroge
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Eunice Ombech
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Mercy Moraa Mokaya
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Emmanuel Kepha Obulemire
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Anil Khamis
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Institute of Education, University College London, 20 Bedford Way, London WC1H 0AL, UK
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi P.O. Box 230-80108, Kenya;
| |
Collapse
|